In a recent randomized trial, we have shown that a physician/nurse team approach for counseling outpatient smokers was relatively easy to institute and maintain, was well accepted by both patients and staff, and significantly enhanced quit attempts and quit rates compared with brief physician advice alone. This team approach used the physician's authority and prestige, but relied on a project nurse counselor and a short video to deliver most cessation information and support. Demands on physician time were limited to an average of 30 seconds per smoker, which led to a high level of cooperation among 40 participating physicians over the one-year project period. Our aim now is to use a four-stage model of organizational diffusion and adoption to demonstrate that the team approach can be implemented and sustained within a random half of 10 large primary care clinics serving the 375,000 members of Kaiser Permanente Northwest Region. Organizational-level diffusion measures, clinic-level implementation effectiveness measures, and patient cessation outcomes will be assessed to gauge implementation effectiveness. Cost and cost-effectiveness will be assessed in detail. A successful demonstration here will serve as an attractive and convincing dissemination model, both for KP regions nationwide (serving 6 million members) and other non-HMO primary care settings.